A Vanderbilt Center for Education and Research in Therapeutics (CERT) is proposed as part of a national collaboration to systematically promote rational pharmacotherapy. The CERTs will work to systematically translate scientific advances into improved clinical outcomes. The theme of the Vanderbilt CERT is Encouraging Rational Pharmacotherapy in Medicaid Managed Care. The Medicaid population is the therapeutic focus because its enrollees are particularly vulnerable to suboptimal pharmacotherapy and that, for a variety of reasons, are underrepresented in extant research. Vulnerable groups include he developing fetus, young children, African-Americans and other minorities, the chronically ill, the elderly, and persons in nursing homes. The Medicaid population also provides an outstanding data source that permits identification of suboptimal pharmacotherapy and evaluation of educational programs. Our focus on managed care emphasizes that an under-recognized determinant of rational pharmacotherapy may be programs and policies implemented by managed care. The goal of the Vanderbilt CERT is to improve pharmacotherapy by combatting three specific threats to rational pharmacotherapy: inadequate knowledge base, suboptimal provider or patient behavior, and counterproductive policies. To this end, the CERT will combine expertise in pharmacoepidemiology, health services research, clinical pharmacology, informatics, biostatististics, and behavioral sciences. The specific aims of the CERT thus are: 1. Improve the knowledge base for rational pharmacotherapy by conducting clinical pharmacologic and pharmacoepidemiologic studies. We propose two pilot studies, one of factors influencing drug penetration of sanctuary sites and another comparing adverse effects of Cox 1 and Cox 2 NSAIDs. 2. Modify suboptimal provider or patient behavior through focused educational programs. 3. Determine the effects of policies on pharmacotherapy and clinical outcomes by conducting rigorous evaluations of program and policy changes.